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General NPI Number Information
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NPI Number | 1528476546
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Entity Type | Individual
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Provider Name | ROXANA KHORRAMI
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Gender | Female
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 300 STEIN PLAZA 2ND FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90095-1927
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Country | US
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Telephone | 310-825-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14941 TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPT14941-TLG
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OPT14941-TLG
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207WX0108X
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Taxonomy Name | Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
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License Number | OPT14941-TLG
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License Number State | CA
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